The 27-hour day

Here is a number every primary care doctor should know: 26.7.

A research team took a panel of 2,500 adults that looks like the US population. They applied the 2020 guidelines for preventive care, chronic disease care, and acute care. Then they added the time for charting and the inbox. (Porter et al., JGIM, 2023)

The answer was 26.7 hours a day for one doctor working alone.

• Preventive care: 14.1 hours
• Chronic disease care: 7.2 hours
• Acute care: 2.2 hours
• Charting and inbox: 3.2 hours

There are 24 hours in a day. The clinic gets about eight of them.

Nobody is lazy

When a screening gets missed or a blood pressure stays high for a year, we tend to look for the person who dropped it. Sometimes there is one. More often the job was simply bigger than the clock, and something had to give.

Doctors already know this. They just don't usually see it written as a number. Once you see it, a lot of things make sense. The rushed visit. The care gap list that never gets shorter. The inbox at 9 PM.

What a team does

The same study asked what happens when the work is shared. Nurses do some of the counseling. Medical assistants close gaps on standing orders. Pharmacists manage some of the chronic medicines. Staff handle forms and routine messages.

With a team, the doctor's share drops to 9.3 hours a day. That is a cut of about two thirds.

It still doesn't fit in eight hours. But it goes from impossible to close. That difference is the whole argument for team-based care.

Panel size is a clinical decision

Run it backward. To fit the recommended care into an eight-hour day, a doctor working alone could care for about 750 adults. With a team, about 2,150.

Most panels are set by a spreadsheet, based on what the visits can pay for. The spreadsheet never asks what each patient will get. It should.

What I take from it

• Stop treating the gap as a personal failure. It is a design problem.
• Staff the work, not the visit. Every task a team member can finish is time the doctor gets back.
• Ask what a panel size buys. Before anyone adds 300 patients, ask which care those 300 will not get.

The day is not too short. The job was built for a bigger one.

I built a dial so you can see it. Drag your own panel size and watch where the day runs out: The 27-Hour Day.